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A Comparative Study on Immediate Effects of Traction Straight Leg And International Jour nal of Applie d Rese arc h 2019; 5(4): 274-278 ISSN Print: 2394-7500 ISSN Online: 2394-5869 A comparative study on immediate effects of traction Impact Factor: 5.2 IJAR 2019; 5(4): 274-278 straight leg and bent leg raise on hamstring muscle www.allresearchjournal.com Received: 07-02-2019 flexibility in normal individuals Accepted: 09-03-2019 Pooja D Kapadia Intern at Late Shree Fakirbhai Pooja D Kapadia and Dr. Virendra K Meshram Pansare Education Foundation’s College Of Abstract Physiotherapy, Nigdi, Pune, Background: Muscular flexibility is an important aspect of normal human function. Limited flexibility Maharashtra, India has been shown to predispose a person to several musculoskeletal overuse injuries and significantly affect a person’s level of function. The objective of our study was to find out the effect of mulligan Dr. Virendra K Meshram Traction Straight Leg Raise (TSLR) on hamstring flexibility, to find out the effect of Mulligan bent Leg Associate Professor, Raise (BLR) on hamstring flexibility & Comparison of Mulligan TSLR & Mulligan BLR on hamstring Department of Cardiovascular and Respiratory flexibility in normal individuals. Physiotherapy, Late Shree Method: For the present study, a total of 124 physiotherapy students were screened; of which 50 adults Fakirbhai Pansare education with hamstring muscle tightness were recruited and randomly divided into two groups: Group A- given Foundation’s College Of Mulligan Traction Straight Leg Raise and Group B- given Mulligan Bent Leg Raise. Hamstring Physiotherapy, Nigdi, Pune, flexibility was measured before and after the application of each stretching technique with the use of sit Maharashtra, India and reach test. Results: Paired t test showed significant improvement in hamstring muscle flexibility on pre-post values for Group A-Traction Straight Leg Raise (12.597 ± 2.842, 17.80 ± 3.060) at p<0.0001. Also, Wilcoxon Signed Rank Test showed significant improvement in hamstring muscle flexibility on pre- post values for Group B-Bent Leg Raise (12.152 ± 3.024, 15.423 ± 2.80) at p<0.0001. However, Traction Straight Leg Raise (5.203±1.518) was more significant than Bent Leg Raise (3.271±1.341) at p<0.0001 on the Mann Whitney Test. Conclusion: Thus both Mulligan’s Traction Straight Leg Raise and Bent leg Raise are effective in improving the hamstring muscle flexibility in normal individuals, but Mulligan’s traction straight leg raise technique was more effective in improving hamstring flexibility. Keywords: Traction Straight Leg Raise, Bent Leg Raise, Hamstring muscle flexibility, Normal Individuals Introduction Flexibility is defined as the ability of a muscle to lengthen, allowing one joint or more to move through a range of motion (ROM), and is an essential component of normal [1, 2] biomechanical functioning . Muscle extensibility is an essential element of biomechanical function [3]. Limited muscle extensibility is a common problem that affects various patient populations as well as healthy able-bodied individuals [4, 5, 6]. The ability of an individual to move smoothly depends on his flexibility, an attribute that enhances both safety and optimal [7] physical activities . Flexibility is an important physiological component of physical fitness, and reduced flexibility can cause inefficiency in the workplace and is also a risk factor for low back pain [7]. The posterior femoral muscles, biceps femoris, semitendinosus, and semimembranosus, are colloquially termed the ‘hamstrings. The flexibility of hamstring muscle is important for general and athletic population and of almost importance for health Correspondence Dr. Virendra K Meshram care professionals, to achieve this goal one needs to know the most effective and efficient [8] Associate Professor, technique to gain hamstring flexibility . Lack of hamstring muscles extensibility conditions Department of Cardiovascular a decrease of pelvic mobility [9]. This invariably leads to biomechanical changes in the and Respiratory pressure distribution of the spine and consequent spinal disorders [10]. Therefore, poor Physiotherapy, Late Shree hamstring extensibility has been associated with thoracic hyper kyphosis [11], spondylolysis Fakirbhai Pansare education [12] [13] [14] [15] Foundation’s College Of , disc herniation changes in lumbopelvic rhythm and low back pain . Hamstring Physiotherapy, Nigdi, Pune, tightness is also associated with low back and lower extremity musculoskeletal disorders Maharashtra, India leading to biomechanical changes of the pelvis and low back [16]. ~ 274 ~ International Journal of Applied Research Stretching techniques are the treatments used to improve moved passively through the range of SLR to the onset of muscular extensibility to improve ROM, and can help discomfort and then immediately returned to the resting prevent damage in daily life or sports, reduce muscle pain, position. Three repetitions of Mulligan’s Traction Straight and improve muscle capability. There are various treatment Leg Raise were done with 7 seconds hold and 5 seconds for the hamstring stretching like active release technique, relax time. The pain free Traction Straight Leg Raise was passive stretching, static stretching [17], PNF Stretching given for 3 repetitions. Techniques [18, 19], eccentric stretching exercises [20] for improving hamstring flexibility. Brian Mulligan has developed a most ingenious compilation of manual techniques. Unlike the other mobilization procedures, Mulligan performed while patients were moving, either actively or passively, or while they were performing a resisted muscle contraction [21]. Indications for use of Mulligan’s Traction Straight Leg Raise (TSLR) and Bent Leg Raise (BLR) techniques are limited range of motion of hip flexion together with low back pain with or without referred leg pain. The intention of this technique is to restore normal mobility. It stretches the lower extremity muscles in combination of hamstring, adductors and rotators. The Traction Straight Leg Raise and Bent Leg Raise techniques are painless interventions that are said to have immediate benefits [22]. Hence this study is designed to compare the effectiveness of two forms of manual therapy interventions such as Traction Straight Leg Raise and Bent Leg Raise Fig 1: Traction Straight Leg Raise Technique techniques on hamstring muscle flexibility. [25] Group B: Mulligan Bent Leg Raise Procedure Participant was in supine lying on a high couch with the The study was conducted in the duration of September 2018 investigator in walk stand position lateral to the leg, which till March 2019. Ethical approval was taken from the ethical was being stretched. Hip and Knee of the side to be committee. Total of 124 physiotherapy students were stretched was bent at 90˚- 90 ˚. Participant's flexed knee was screened for hamstring muscle tightness. Hamstring muscle placed over the shoulder, the popliteal fossa of the knee tightness was assessed using 90-90 hip and knee extension resting on the shoulder. A distraction (longitudinal traction test. Subjects were in a supine position. Passive flexion of force along the long axis of femur) was applied at the lower hip joint was done while the knee was fully extended to the end of femur and the participant was asked to push the end point where firm resistance was detected in the shoulder with his or her leg followed by voluntary hamstring muscle group. Any person whose contra lateral relaxation. The traction was maintained throughout the hip goes into flexion will be included for the intervention. technique. At this point of relaxation, the bent knee was Total of 50 students were selected based upon the inclusion pushed up as far as possible in the direction of the shoulder and exclusion criteria. Inclusion Criteria- 1.Physiotherapy on the same side in a pain free range. This stretch was students. 2. Age 18-25 years. 3. Hamstring muscle tightness sustained for 7 seconds and then 5 seconds of relaxation. If - 90-90 hip knee extension test positive. Exclusion Criteria- the pain or restriction eased, the hip was taken further in to 1.Any musculoskeletal pain or deformities of the lower flexion. It was ensured that there was no pain during the extremity. 2. Any neurological symptoms affecting the procedure; if it was painful the direction of the leg raise was lower limbs. 3. Subjects performing regular exercises or altered medially or laterally. The process was repeated 3 stretching. 4. Non willing population. Participants were times till the knee of the participant was beyond the informed about the aim, objective and method of the study. shoulder of therapist. The contra lateral leg was kept relaxed Samples were divided into 2 random groups via lottery and allowed to move as it goes. system- Group A and Group B. Pre-interventional readings for hamstring flexibility was taken using the sit and reach test. Group A (n=25) was given Mulligan’s Traction Straight Leg raise (TSLR) technique. Whereas, Group B (n=25) was given Mulligan’s Bent Leg Raise (BLR) technique. Immediate post-interventional readings for hamstring flexibility was taken using the sit and reach test. The data was then analyzed and results were obtained. Outcome Measure was Sit-and-reach (SR) test in which a fingertips-to-tangent feet distance is measured are probably the most widely used lineal measures of flexibility. Group A: Mulligan Traction Straight Leg Raise [24] The subjects lay supine with their arms by their sides and a single pillow under the head. Sustained maximum traction force to the limb, applied in line with the long axis of the leg, with the knee extended. The limb was simultaneously Fig 2: Mulligan’s Bent Leg Raise Technique ~ 275 ~ International Journal of Applied Research Data analysis and results using Paired t test. (Table 1) Group B given Bent Leg Raise Statistical analyses were performed using the Graph Pad (n=25) statistical analysis of uneven distribution of data was INSTAT software. Total sample of 50 was divided into two done using the Wilcoxon Signed Rank Test. (Table 1) The groups. Group A -Traction Straight Leg Raise (n=25) comparison between data of Group A and Group B was statistical analysis of normally distributed data was done done using Mann- Whitney Test.
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